Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder in Patients with Chronic Pain

作     者：Satoshi Kasahara Yumiko Okamura Ko Matsudaira Hiroyuki Oka Yoshie Suzuki Yasuko Murakami Toshiharu Tazawa Hayato Shimazaki Shin-ichi Niwa Yoshitsugu Yamada 

作者机构：Anesthesiology and Pain Relief Center Faculty of Medicine University of Tokyo Tokyo Japan Department of Neuropsychiatry Faculty of Medicine University of Tokyo Tokyo Japan Department of Medical Research and Management for Musculoskeletal Pain 22nd Century Medical and Research Center Faculty of Medicine University of Tokyo Tokyo Japan Department of Anesthesiology and Pain Medicine Faculty of Medicine Juntendo University Tokyo Japan Department of Anesthesiology and Pain Medicine Yokohama City University Medical Center Yokohama Japan Department of Psychiatry Jikei University School of Medicine Tokyo Japan Department of Psychiatry Aizu Medical Center Fukushima Medical University Fukushima Japan 

出 版 物：《Open Journal of Psychiatry》 (精神病学期刊（英文）)

年 卷 期：2017年第7卷第4期

页      面：261-275页

学科分类：1002[医学-临床医学] 100214[医学-肿瘤学] 10[医学] 

主　　题：Atomoxetine Attention Deficit Hyperactivity Disorder Chronic Pain Methylphenidate Wender Utah Rating Scale 

摘      要：Aims: To investigate rates of attention-deficit hyperactivity disorder (ADHD) in patients with chronic pain attending a pain clinic, the effects of a screening measure for ADHD in patients with chronic pain, and the effects of ADHD drugs on both pain and ADHD symptoms. Methods: We retrospectively surveyed 110 patients with chronic pain visiting the Anesthesiology and Pain Relief Center at the University of Tokyo in Japan, who had also consulted a psychiatrist, between April 2012 and July 2015. Results: Of the total of 110 patients with chronic pain, 35 (31.8%) were also diagnosed with ADHD, and the average Wender Utah Rating Scale (WURS) score among the ADHD patients was 39.0 ± 22.1 (n = 25). Only 36.0% of these patients exceeded the cutoff value, suggesting that 64.0% of the patients with ADHD were not identified by screening with the WURS. Twenty-six patients initiated treatment with ADHD medication, with dosage adjustment completed in 21. Of these 21 patients 20 (95.0%) had improved ADHD symptoms. Improved pain symptoms were observed in 14 patients (66.6%), with a reduction in the pain numerical rating scale of 64.7% ± 30.1%. Conclusions: This is the first study investigating the comorbidity of ADHD and chronic pain at pain clinics showing a high level of comorbidity and amelioration of pain and ADHD symptoms with treatment. Careful interpretation is required when the WURS is used to screen patients with chronic pain.